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The Lucy Letby drama took a new twist yesterday. Three of the bosses at her former hospital were arrested on suspicion of gross-negligence, manslaughter.
Arresting managers is a highly unusual step.
I think most fair minded people would say Letby’s convictions, based on what we now know are at best, unsafe and deserve another look.
If Lucy Letby didn’t kill those babies, then what exactly are we accusing the managers of failing to stop?
Arresting people for not preventing a crime that may not have happened isn’t justice, it’s theatre.
Neonatal death is a grim, tragic part of life. Before we start putting people in handcuffs, we’d better be damn sure a crime took place and right now… who can say for certain, it has.
If we’re not careful, this will look less like accountability and more like a desperate search for scapegoats.
Unless the Letby convictions are upheld with renewed confidence and the causal chain to managerial inaction is proven, this pursuit of managers risks looking untimely and sinister.
This is a really delicate moment with justice and patience held in balance.
The arrests are for gross-negligence, manslaughter which applies when an individual owes a duty of care and breaches it through gross negligence.
It is a criminal charge and the threshold is; ‘beyond reasonable doubt’.
The Crown must first prove, each manager held a legal duty… such as overseeing neonatal care protocols.
The breach must be so severe it amounts to a ‘crime’ in law… such as ignoring reports of unusual baby collapses or failing to act if infant mortality spiked.
The prosecution must link managerial failings directly to specific infant deaths. For example if managers failed to investigate a cluster of collapses or delayed interventions that if done promptly could have saved lives.
It must be shown…
'...a reasonable manager in their position would have foreseen the risk of death from their inaction.'
Negligence must surpass mere incompetence, entering the domain of a serious disregard for safety.
Why have the arrest been made now? It’s difficult to say. Most likely to preserve emails and evidence chains.
Internal records, meeting minutes that might have shown warnings were dismissed or de-prioritised. Emails or memos revealing decisions to override or ignore safety protocols. NHS incident reports, statistics, documenting trends that were not acted upon.
There is also the issue of the ‘guiding hand’.
A manager or board member may not be ‘at the bedside’ but might be held responsible if their decisions (or indecision) shaped the culture or risk environment.
In effect, a guiding hand in dysfunction.
We are told managers were aware of safety concerns raised by consultants. It is alleged they discouraged escalation or whistleblowing and refused to remove Letby from duty or report her to the police.
It is claimed they prioritised reputation or internal politics over patient safety. If proven, this could be framed as the ‘guiding hand of negligence’. People whose decisions enabled avoidable deaths.
In the history of NHS management this is a very significant moment.
The legal threshold is high. Poor management or vague suspicion won’t do. It requires demonstrating that leaders actively risked lives through serious negligence.
Neonatal deaths are sadly not rare.
- The expected NHS benchmark is ~2.9 neonatal deaths per 1,000 live births.
- Full‑term infants; ~0.5 per 1,000.
- Extremely preterm, orders of magnitude higher; ~780 per 1,000.
The Countess of Chester had elevated figures; 1.91 vs 1.27 per 1,000 in 2015.
As a result, the hospital commissioned a RCPCH review in 2016. It confirmed system level improvements, no criminal negligence or identifying causes.
Medical ambiguity, clinical complexity, forensic limitations make causation difficult to divine.
Proving someone’s management decisions caused a baby’s death in a neonatal unit, beyond reasonable doubt is extremely difficult, even with abnormal statistical clusters.
If this case is pursued it will redefine management relationships with clinicians.
In the NHS there is no room for poor management neither for bad clinicians. We all know because of workforce issues, historic funding problems and investment, parts of the NHS are probably not safe.
Nurses and midwives write to me regularly with stories of unsafe staffing.
Doctors tell me of near misses with clunky IT systems and path reports.
Managers email about dangerous estates and impossible resource allocation problems.
The NHS is fraught with dangers, the guiding hand for which can often be traced to a desk in Whitehall.
And…
... let’s not forget…
... buried in all this tension and accusation, and investigation are the families of the babies...
... for whom it now seems closure is to be pushed even further away.
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